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KROK 2 Medicine 2023 Questions | KROKEXAM
Browse 2023 KROK 2 Medicine exam questions with answers and explanations.
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A newborn boy was brought into a hospital on the second day after the onset of the disease. His parents complain of his fussiness, regurgitation, fever of 38.5 ° C, red skin with infiltration in the area of his lower back. Objectively, the child is in a severe condition, inert, pale, suckles poorly. In the lumbar region, on the sacrum, and on the buttocks there is an infiltration with hyperemic areas and a soft spot 8x7 cm in its center. The stool is 10 times per 24 hours with green coloring and mucus. What is the most likely diagnosis in this case?
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A 32-year-old patient suffers from epilepsy. Suddenly, without any cause, the patient became excited. Objectively, the patient is disoriented in the personal identity and environment, has visual and auditory hallucinations of threatening content and delusional ideas of reference and persecution. There are expressions of fear, anger, and rage on the patient's face. The patient's behavior is aggressive, accompanied by destructive actions. What psychopathological syndrome is it
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A 14-year-old girl is being examined by a pediatrician. Objectively, she has a tall stature, asthenic body type, striae on the skin of the abdomen, blue sclera. She was diagnosed with a scoliotic posture and chest deformity. She has hypermobile joints; her fingers and arms are long. Cardiac ultrasound visualizes a mitral valve prolapse. What is the most likely because of her tall stature?
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A 35-year-old man was found dead in his own garage. Forensic examination detects the following: horizontal closed strangulation mark, petechial hemorrhages on the skin of the head and neck, facial cyanosis, marked livor mortis, and multiple Tardieu spots. What indicates that the man did not die by hanging?
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During preventive medical examination, one of the students at a technical lyceum shows signs of cheilosis that manifests as maceration of the epithelium in the place where the lips close. The lips are bright red, with isolated vertical fissures covered in red brown scabs. These clinical signs are most likely caused by the insufficient intake of a certain substance with food. Name this substance.
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A 3-year-old boy has been hospitalized with severe edemas. Objectively, the boy is pale, his blood pressure is 90/60 mm Hg, he has oliguria. General urinalysis shows the following: color- yellow, specific gravity 1020, protein levels-3.5 g / L, erythrocytes leached,4-5 in the vision field, leukocytes 2-3 in the vision field, 24-hour proteinuria 6.6 g. The cholesterol levels are 9.8 mmol/L. What next step in the patient's management would be optimal?
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A 45-year-old patient was referred for a consultation with a psychiatrist due to complaints of abdominal pain and discomfort that occur in emotionally straining situations. Objectively, no changes of the gastrointestinal tract were detected. The complaints first arose over 10 years the background of a severe alcohol poisoning against. The patient has been repeatedly visiting gastroenterologists, who were unable to find any gastrointestinal pathology in the patient. The prescribed therapy was ineffective. What condition is most likely in the patient?
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A 55-year-old woman complains of deformed finger joints and pain in them during movements. Objectively, there are small bony formations on the lateral surfaces of the distal interphalangeal joints. The formations are slightly painful to palpation. What are they called?
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A 25-year-old woman was hospitalized at 11 weeks of pregnancy with complaints of pain in her lower abdomen. Two weeks ago she had a severe case of rubella. Bimanual examination detects a formed cervix, the cervical inlet is closed, the uterus is enlarged up to 11 weeks of pregnancy, the uterine appendages are normal. What treatment tactics would be optimal in this case?
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The pregnancy is first, the term of gestation is 38 weeks. The fetus is in the longitudinal lie, the presentation is cephalic, with the head pressed against the entrance to the lesser pelvis. The expected weight of the fetus is 3500.0 g. Contractions occur every 5 minutes and last for 25-30 seconds. The fetal heartbeat is 130 / min., clear and rhythmic Vaginal examination shows that the cervix is shortened to 1 cm, the cervical canal allows inserting 1 finger width (2 cm). The amniotic sac is intact. What labor management tactics should be chosen in this case?
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A pregnant woman at 38 weeks of pregnancy was hospitalized into the maternity hospital with complaints of a small amount of bloody discharge from the genital tracts and a sharp pain in her entire abdomen that started one hour ago. No labor activity can be detected. Objectively, the patient is pale, her pulse is 100 / min., her blood pressure is 100/60 mm Hg, no fetal heartbeat. Palpation detects tense and painful uterus. Make the diagnosis.
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A 20-year-old woman is being treated for anemia (hemoglobin-72 g/L). A year and a half ago, she had an involuntary miscarriage with a significant blood loss at 16 weeks of pregnancy, after which the woman developed memory deterioration, fatigability, of appetite, dry skin, brittle nails, and irregular menstrual cycles. Objectively, the following is observed: blood pressure 80/55 mm Hg, pulse - 54/min., height - 168 cm, weight-48 kg, genital hypoplasia. What medicine would be the optimal choice for this patient?
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It was found that for every 100 births, women with risk factors had 30 preterm births, while women without risk factors had 5 preterm births. What statistical method of data processing would be optimal for a doctor to use to estimate the validity of differences between the groups that are being compared?
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What is the type of joint action, where the overall effect on the human body is less than the sum of the individual effects of each separate substance included in the combination?
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A 12-year-old child has been diagnosed with bilateral pneumonia of mycoplasma etiology with mild disease course. What drug must be prescribed for treatment in this case
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A woman with polycystic kidney disease observes an increase in her 24-hour urine output to 2-2.5 liters. Dynamic nephroscintigraphy shows the following: total glomerular filtration rate 34 mL / min., serum creatinine-84 mcmol / L, urea-8.0 mmol /
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Several chemical substances enter the human body from atmospheric air. What is the type of joint action, where the overall effect on the human body is more than the sum of the individual effects of each separate substance included in the combination?
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A 46-year-old man came to a doctor with complaints of a rash on his hands that appeared one week ago and is accompanied by severe itching. The patient has a history of bronchial asthma and has seasonal allergies. Physical examination detects dry skin of the hands and multiple erythematous papules and vesicles with scrous contents, as well as areas of lichenification and excoriation, on the back of both hands. What is the most likely diagnosis in this case?
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A person diagnosed with a urogenital chlamydial infection based on the clinical manifestations and laboratory examination data has made an appointment with a venereologist. What will be the main component of the therapy prescribed for this patient
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A 37-year-old patient was repeatedly treated in a psychiatric hospital. The current hospitalization was due to behavioral disorders in the form of reticence, refusal to eat, periodical chaotic excitement with stereotyped movements. During the examination, the patient is sluggish, remains in bed, and no contact with him can be made. He does not answer any questions, his position is monotonous, he is hypomimic. The " proboscis " sign, the waxy flexibility of the muscles, and the " psychological pillow sign are observed. This condition lasts for a week already. What is the provisional diagnosis in this case?
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A 63-year-old man came to a doctor with complaints of marked general weakness, poor appetite, weight loss, joint pain, and heaviness in the right subcostal area. Complete blood count shows the following: erythrocytes 3.4*10^12 / L, Hb-102 g /L, color index-0.9, platelets-640 *10⁹ / L, leukocytes-138 *10^9 / L, blasts -1 %, promyelocytes-2 %, myelocytes-13 %, juvenile-12 %, band neutrophils-16 %, segmented neutrophils-31 %, basophils-3 %, cosinophils-8 %, lymphocytes-9 %, monocytes-5 %, ESR-30 mm / hour. What is the provisional diagnosis
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A 5-year-old child became acutely ill with the fever of 39.2°C. one episode of vomiting, complaints of cramping pain in the abdomen, tenesmus, and of movements that produce a sequent bowel feces and a large amount of mucus with pus and blood streaks. Examination detects a dense sigmoid colon that is painful to palpation. Make the diagnosis.
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Two weeks after a case of tonsillitis, a 29-year-old patient noticed facial edema, weakness, and decreased work capacity. Gradually, he developed shortness of breath, leg edema, and lumbar edema. Objectively, his skin is pale, his heart sounds are weakened, he has hydrothorax, anasarca, and blood pressure of 150/100 mm Hg. Clinical urinalysis shows the following: specific gravity-1021, protein-9 g / L, erythrocytes 40-50 in the vision field, hyaline casts – 4-6 in the vision field. What is the provisional diagnosis in this case?
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A pediatrician needs to analyze the infant mortality rates. What must be taken as the unit of observation for this purpose?
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A 42-year-old man, a miner, was freed after 12 hours spent under the rubble. Objectively, his both lower legs and feet are pale; there is no pulsation on the peripheral vessels, no sensitivity, and no passive movements in the joints. He was hospitalized with tourniquets applied to both limbs. What urgent first aid must be provided in this case to prevent myoglobinuria and acute kidney failure?
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A 30-year-old woman came to a doctor with complaints of menstruation that have been missing for two years after her second childbirth. The childbirth was complicated by a massive bleeding. After giving birth, the woman started noticing hair loss and weight loss. Objectively, the woman's body type is asthenic, her external genitalia are hypoplastic, the cervix is cylindrical, the body of the uterus is small and painless, the uterine appendages cannot be detected. What is the most likely diagnosis in this case?
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A baby with the gestation term of 30 weeks was born with the body weight of 1100.0 g. Three hours after birth, frequent apneas appeared, "gasping" type of breathing is observed, the heart rate is 98 /min. The Silverman score is 9 points. Additional oxygenation did not improve the child's condition. What must the doctor do next?
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Among the population living near a pesticide production factory, the number of congenital malformations that manifest as central paralysis, idiocy, and blindness of newborns is dynamically increasing. Compounds of what chemical substance can cause the development of these pathologies?
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A 32-year-old patient looks at the pattern on the wallpaper and sees the lines begin to move and form silhouettes of fantastic animals. Instead of a lighting fixture hanging from the ceiling, he sees a giant octopus. What psychopathological symptom is it?
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A pregnant woman suffers from essential hypertension of the first degree. At 35 weeks of gestation, she developed edemas of the legs and anterior abdominal wall. Her 24-hour urine protein is 5 g/L, the blood pressure increased to 170/120 mm Hg. She developed a headache and her vision became worse. Four hours of intensive treatment had no effect. What tactics would be necessary in this case?
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A 52-year-old woman came to a doctor for her annual preventive checkup. Her father has a history of cardiovascular disease. Physical examination of the woman shows the following: height-172 cm, weight 77 kg, BMI-26 kg / m², body temperature 36.8°C, pulse 81 / min., respiratory rate 16 / min., blood pressure-160/100 mm Hg on both hands. Ophthalmoscopy of the Fundus detects narrowing of the retinal vessels Laboratory values are within the normal range. What should be prescribed in this case to reduce the patient's risk of death caused by cardiovascular diseases?
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A 36-year-old man came to a doctor with complaints of burning retrosternal pain that usually occurs 1-1.5 hours after eating and becomes worse in a horizontal position. Esophagogastroduodenoscopy (EGD test) detects two lesion foci in the lower third of the esophageal mucosa. The foci are up to 5 mm in size and located within one-fold. What tactics would be optimal in this case?
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A 58-year-old man had a moderate ischemic stroke in the right hemisphere of the brain 10 days ago. At the time of hospitalization, the deficit score on the NIHSS scale was 9 points. He suffers from moderate arterial hypertension, atrial fibrillation, urolithiasis, and gout (remission). What must be prescribed to the patient for secondary prevention of stroke?
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An 18-year-old young man came to a doctor with complaints of cramping abdominal pain, frequent liquid stools with mucus and fresh blood. The symptoms have been observed for the last four months, during which the patient lost 10 kg. Physical examination shows soft abdomen, painful on the left along the large intestine; the sigmoid colon is spastic. Complete blood count shows the following: erythrocytes-3.2-10¹2 / L, hemoglobin-92 g / L, leukocytes -10.6 10 % / L, ESR-34 mm/hour. Bacteriological culture of feces shows negative results. Colonoscopy revealed inflammation of the large intestine with the loss of vascular pattern, as well as an area of increased bleeding with clear boundaries. What treatment tactics should be chosen for this patient?
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For three weeks, a 29-year-old patient has been observing a painless ulcer on the skin of the vermilion border of the lower lip The last week, the ulcer became accompanied by significant edema of the underlying and surrounding tissues. Examination shows an ulcer up to 2.5-3 cm in diameter, with. clear margins, the bottom that resembles " old lard in color, and an underlying cartilaginous infiltrate. What laboratory test must be prescribed first in this case?
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After eating mushrooms, a 30-year-old person developed nausea, vomiting, and absence of urination. On the third day after the onset of the symptoms, this person sought medical aid. Laboratory tests show elevated creatinine levels of 700 mcmol /L. and urea levels of 32 mmol /L. What treatment tactics should be chosen in this case?
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A 2-year-old child suffers from frequent and long-lasting respiratory diseases and pancreatogenic malabsorption. Mucoviscidosis (cystic fibrosis) is suspected. What study is necessary to confirm this diagnosis
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A 45-year-old man came to a doctor complaining of a sore throat and fever that last for ten days. The patient has a history of ulcerative colitis, is a smoker, and has been smoking one pack of cigarettes per day for ten years. The patient's father died of cancer of the large intestine at the age of 50. Physical examination shows the following: body temperature-38.6 ° C, blood pressure-130/80 mm Hg, pulse- 72 / min., respiratory rate-18 / min. Examination of the oral cavity reveals erythematous pharynx and exudate in the tonsillar crypt. Antigen test for group A streptococcus was positive. What procedure that doctor can recommend for secondary prevention of cancer would be optimal for this patient?
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A man was undergoing treatment for a myocardial infarction. On day 13, his chest pain increased and he developed shortness of breath. Objectively, the following is observed: temperature-38.2° C, pulse respiration rate 112 / min.,26 / min., fine bubbling crackles can be heard under the right shoulder blade. On day 15, he was diagnosed with right-sided exudative pleurisy. Complete blood count shows the following: leukocytes – 8.9*109/L, eosinophils-8 %. ESR-24 mm/hour. What complication of myocardial infarction occurred in this patient?
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During preventive medical examination of middle and high school students, doctors were determining, whether the biological development of children matches their calendar age. For this purpose, the doctors were using the following criteria: annual increase in body length, ossification of hand bones, number of permanent teeth. What additional developmental indicator should the doctors include when examining children at this age?
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